'Any spotting?' the Doctor Asks—and Uterine Cancer is Diagnosed

Carol PerrusoSpecial to The Times

ROUTINE best describes this year's visit to my gynecologist. I had no medical complaints; I was just working through my to-do list. After a physical exam and a brief conversation about life and the latest research, my doctor of 15 years said everything looked good. My Pap smear would later prove normal.

So how did I end up three months later diagnosed with, and cured of, uterine cancer? The answer is as simple as a two-word question, and as complex as health insurance economics.

The question came at the end of my appointment as my doctor was writing prescriptions for hormone pills: "Any spotting?" It sounded like an afterthought, but it jogged my memory. I'd had a quarter-sized spot of blood a few weeks earlier -- so unremarkable I hadn't thought to mention it.

My answer prompted an ultrasound, which revealed a polyp, which he removed. Everything looks good, he said again. No thickening of the uterine lining, which can indicate cancer. I expected confirmation by postcard.

I received a phone call instead. The polyp contained cancer. "This is better than the best-case scenario," he said, because it wasn't in the uterine lining and the cancer had likely been eliminated along with the polyp. A hysterectomy was still recommended, though. It confirmed that the cancer had been caught, but the procedure also removed some precancerous cells. No chemo or radiation needed: I was "cured."

Despite my relief, I kept replaying that question that started it all: "Any spotting?" How easy it would have been, with patients waiting, to forget. Surely in my own career, deadlines and the dulling effect of repetitive tasks had led to lapses. Doctors are equally human. And the economics of health insurance create a system in which there's often too little time for too many patients.

My gynecologist took a different economic path, one I believe contributed to early detection of my cancer. Perhaps he had the time to be thorough, to see me as more than a routine pelvic exam, to ask that simple question, because he does not take insurance. With fewer insurance-related expenses and hassles, there's more time for patients, teaching, research and staying current, all of which make him the kind of doctor everyone wishes for.

My part of the economic bargain was higher out-of-pocket payments to see a "non-network provider," knowing that those minimal, once-a-year costs could balloon with a serious illness. Fortunately, I've been able to afford that risk. It was a conscious choice, with no regrets. I have come to rely on the quality of his care and his more holistic approach to my health.

Would a gynecologist in my insurance plan have asked about spotting and done the same follow-up? I hope. Did that question save my life? Maybe not directly. Uterine cancer typically develops slowly, and additional bleeding might have sent me back to the doctor -- eventually. But the bottom line is, those cancer cells would be there today and multiplying. The result might not be a "better than the best-case scenario."

Carol Perruso is a librarian at Cal State Long Beach and a former L.A. Times journalist. Her physician is Dr. William H. Parker, a Santa Monica gynecologist and a clinical professor at the UCLA School of Medicine.